"Who's the youngest person in here?" asked Dr. Jay Parkinson, a 33-year-old doctor cum entrepreneur to a group of medical students gathered recently in New York-based Mt. Sinai Hospital's student lounge. A girl raised her hand. She was born in 1988. "That's how I start all my talks," Parkinson said, "but usually I'm talking to old people. They're just figuring out what Facebook is and all that crap that everyone already hates by now." The students giggle, a little uneasily. It's clear that the guy standing before them in skinny black jeans and a rumpled denim shirt is not the sort of speaker they're accustomed to seeing. Even the invite they received, via Facebook, is not the sort of posting typically seen around Mt. Sinai Med. "Hello Health is revolutionizing health care using our familiar procrastination technology," it said. "Beer and snacks will be served!" (Article continued below...)
A true believer, Parkinson announces, "We're here to share the gospel." And in the next hour, as he explains his ideas for reinventing the way Americans get primary care, Parkinson seems to do just that. One part doctor, one part tech innovator, one part salesman: the sum of those parts have made Parkinson the face of a new kind of health care. At his New York City clinic, his team of doctors uses dozens of means of communication—instant messaging, e-mail, texting, etc.—to communicate with their patients and each other. They are working on a platform that could allow doctors across the country to do the same. And they say that by streamlining health-care delivery, partly by refusing to deal with health insurance, they're improving how primary care is delivered, making it more appealing to young doctors and improving the medical system as we know it. But is the model really a revolution?
With all the social-networking jargon, it's easy to chalk up Parkinson's philosophy as just a hipster marketing tactic, but if he gets his way, his practice and forthcoming online platform could radicalize the way many doctors practice, the way patients pay and the choices that these students will make about their own careers.
Countless industries from publishing to retail sales have been revolutionized by the Internet: consider eBay, Craigslist, the Huffington Post and Amazon.com. Medicine is one of the last frontiers. By some estimates, less than 25 percent of American physicians use computers to record and track basic information about their patients. Parkinson thinks that even that figure is high. He believes the fact that medicine is so technologically inept is inseparable from the state of health care in America, where we spend double per capita on health-care costs than our closest competitor, and where, he adds, doctors are paid to practice more, not better, medicine. "I think we can do things better," he often says. "And I think we can do it cheaper."
Hello Health started in 2007 in Williamsburg, Brooklyn, ground zero of hipster U.S.A. Parkinson, a trained pediatrician with a master's degree in public health, wanted to practice primary-care medicine, but balked at the high overhead and the meager pay. He was hundreds of thousands of dollars deep in student-loan debt, and the $77,000 a year he could make as a pediatrician in Connecticut seemed a paltry sum. So, he did what scores of young entrepreneurs are doing in their own various ways: Parkinson set up a Web site. Potential patients could make an appointment by highlighting a time on his Google Calendar. They filled in their name, address and what was wrong with them, and Parkinson would show up at their homes. They paid later through PayPal. Within weeks, local blogs had noticed his tiny practice, he was asked to appear on "The Colbert Report," he got two book offers and film deals. "It was amazing," Parkinson recalls. "People are just longing for something better. We all know that medicine sucks." Then he got a call from a Canada-based software company, Myca, and Hello Health was born.
Today, the practice operates out of a storefront space in Williamsburg with a decidedly sleek aesthetic. The waiting space is about as different as you can get from the traditional doctor's office. There are no receptionists, no file cabinets; there aren't even any magazines in the waiting area. There are just a couple of doctors (the practice has three, not including Parkinson, who isn't practicing at the moment so that he can focus on his bigger projects), working on their laptops (made by Apple, of course) and tapping on their iPhones.
Patients, who pay $35 a month for membership, make appointments online, highlighting their time slot on a sliding bar. The first appointment must be face-to-face, but after that, patients can follow up with e-mails, schedule a time to video chat or instant-message with their doctor. Visits like those, that take place in real time, cost money, but e-mails and texts are free. And all their files, all their records, even notes about their appointments, are there on Hello Health's custom-designed Web platform, privacy protected and only available to the patient and his or her team.
Appointments run $150 for the first hourlong meeting, and $200 an hour after that. If a patient has health insurance, they can submit the receipt for doctor's visits and any tests or outside procedures they need to their insurer, but they have to handle all that themselves. As a result, about 50 percent of the few hundred patients are insured. Parkinson and his team recommend that patients pay for high-deductible catastrophic insurance to cover hospital stays, but rely on Hello Health for their day-to-day care. Catastrophic plans typically only cover health-care costs of more than $10,000 or so, but can cost as low as $100 a month for individuals, a fraction of what a comprehensive health-care plan would cost.
For some, including many of the med students listening to Parkinson that night, there lies the rub. Many health-care activists and self-described "idealistic" medical students believe that universal access to comprehensive health care is of paramount importance, and nowhere does Parkinson mention that issue. Under his system, patients have to pay out of pocket, up-front costs to get preventative care and, as problems arise, they must continue to pay for tests, treatments and the like. "Any time you create financial barriers to care, there's a problem," says Richard Kirsch of Health Care for America Now. "Moving toward catastrophic plans is the total wrong direction for health care. What happens if you get a diagnosis [from Hello Health's doctors] and you don't have the other $900 to treat it? This is a stopgap measure to deal with the fact that the system is so screwed up. It's not a long-term solution."
Kirsch's organization is advocating for something close to universal health-care coverage that would work with traditional insurers, what President Obama is also trying to push through. But that plan does not begin to solve the problem of the dearth of primary-care practitioners in the United States. And primary care is the key to the preventative medicine that Obama's plan is counting on to reduce health costs.
In the United States, roughly 75 percent of doctors are specialists—in most other countries, 75 percent of doctors are in primary care. Practicing primary-care medicine isn't nearly as lucrative as specialties, and doctors spend the bulk of their days dealing with insurance claims, or packing in as many patients as possible in order to keep their practices in the black. Massachusetts recently passed a universal health-care program, but it's facing a tremendous shortage of doctors. Only 10 percent of primary-care doctors there are accepting new patients, and the average waiting period to see a primary-care physician exceeds 30 days.
Parkinson says his strategy could help fill this gap. At Hello Health, doctors are able to practice primary-care medicine at specialist salaries. And Parkinson is not shy about his capitalist instincts. The students at Mt. Sinai, brimming with youthful idealism, are a tougher sell. "How much are you guys in debt?" he asks them. "I'm in $220k. Doctors take home 11 percent of the money spent on medicine in this country. It's all middlemen. But the essence of the health-care system is you meeting with your doctor in a room." There are 4.5 people hired per every doctor at a doctor's office, he tells them. "We don't need receptionists anymore," he says. "We don't need fax machines anymore. We don't need paper anymore. We have the Internet. We can do it ourselves."
With virtually no overhead, Hello Health doctors who have a full eight-hour day of appointments will bring home $1,600 a day before taxes. With two weeks of vacation time, that's $400,000 a year, more than twice the average made by family-medicine practitioners. But a huge reason they're able to do that is their refusal to deal with insurance companies. For patients who are insured, the onus is on them to submit the receipts and get reimbursed. Other patients pay out-of-pocket. But Hello Health says they refer them to providers that do testing for the lowest possible costs.
Kirsch concedes that the current bureaucracy is getting in the way of care. "The insurance companies are absolutely maddening in terms of collecting payments," he says. "But rather than saying, 'They're so maddening, we just shouldn't deal with them,' let's have a system in which there's electronic billing and standardized claims. Providing good primary care is one thing, but you want a system in which people get good primary care without financial barriers." In today's tough economic times, paying hundreds of dollars for a procedure or examination that may not seem entirely necessary can be a detriment to ensuring comprehensive and preventative care. And according to Kirsch, it's in everyone's interest to get more Americans treated before they get sick and place burdens on hospitals or emergency rooms.
Parkinson has heard these arguments before. But his primary focus is on improving the efficiency of health-care and doctor-patient communication through technology, which he thinks will greatly benefit medicine. A team of Web developers is putting the finishing touches on the Hello Health Internet platform, set to launch on July 1, which will make their communications system available to doctors at other practices. His partner company Myca will get 7 percent of the revenue generated from the visits the doctors schedule online. The platform will also offer a social-networking function for doctors that will enable collaboration beyond just friending. Like doctor-focused social-networking sites Sermo and Medscape Physician Connect, doctors will be able to consult to each other by posting images of, say, a skin disorder and ask rosacea experts if they agree with that diagnosis. They'll also use text messaging to collect important ongoing data from patients--diabetes patients, for example, will get texts three times a day asking for their blood-sugar levels. That data is collected on their personal pages, and can be referenced later by any member of their team. Groups will be created so that patients dealing with similar diagnoses can communicate with each other, and doctors can send them new studies and information immediately.
"Innovation never comes from within a system," Parkinson tells the students. "We're starting with those who get it. Facebook started in 2004 at Harvard. It wouldn't have started with old people. But you know what sucks? Now your mom is friending you." The entire room erupts in laughter. "That just happened to me!" one student shouts out. They get it. When Parkinson opens the session up for questions, five hands shoot up. "OK, obviously, this is awesome," a baby-faced student in a Williams College sweatshirt says. "That's very clear. So, what are the drawbacks?" Parkinson smiles, and shrugs. Other young voices pipe in, echoing Kirsch's concerns about the need for universal health-care coverage and asking questions about what happens if a patient needs to be admitted to a hospital where costs could skyrocket. "Listen," Parkinson tells them, "We're not trying to fix health care right now. You have to be extremely focused as an entrepreneur. You can't fix every problem." For a system so broken, it might be a decent start.